Common Mental Health Issues
Women’s Sexual Issues
Men’s Sexual Issues
Delayed ejaculation is difficulty achieving ejaculation or orgasm or where you cannot “cum” easily or it takes a long time to “cum”. It may be present if you cannot ejaculate through penetration, or take what you and your partner feel to be an excessively long time. Delayed ejaculation once known as retarded ejaculation. Other terms include: inhibited ejaculation, ejaculatory incompetence, retarded ejaculation, male orgasmic disorder, and anaorgasmia. Retrograde ejaculation is not the same as delayed ejaculation. Retrograde ejaculation is where a man ejaculates into his bladder. If you have been diagnosed with retrograde ejaculation please speak to your urologist.
Taking time to ejaculate may not have seemed a problem when you were younger. Being able to last two hours may be fun when you are masturbating. Being able to last a little longer when you you first began to have sex, may have meant you were popular with your sexual partners. In a relationship though, and especially if you are trying to have children, not being able to ejaculate, delayed ejaculation, can become a major issue for the relationship, your partner and you.
You and your partner may become sore from the sex. You may become frustrated and stop enjoying the sexual act. Your partner may become resentful or insulted that he or she cannot bring you to orgasm, as this seems to be focus in many couple’s sexual activities. It is common for men who experience delayed ejaculation to have broken relationships as their partner wishes to be with a person who can cum, or ejaculate.
Delayed ejaculation can impact on you, your partner and your relationship. Some of the impacts can also include:
- Diminished sexual pleasure for a man and/or his partner
- Anxiety and stress about sexual performance (which can lead to further issues with sexual performance
- Relationship issues due to an unsatisfactory sex life
- Difficulty conceiving (male infertility)
If delayed ejaculation is not treated and addressed, you may also experience:
- Avoidance of sex/sexual contact and loss of intimacy
- Inhibited sexual desire
- Sexual dissatisfaction
- Sexual anxiety and performance issues
- Relationship stress
- Sexual dissatisfaction
If you think you are experiencing delayed ejaculation contact Dr Christopher today on (03) 9005 5213 to make an appointment and find out how the team at Sex Life Therapy can assist you to achieve a better sex life. Sex Life Therapy provides specialist sex therapy in Melbourne at East Melbourne and Frankston (Mornington Peninsula). Skype counselling is also available.
If you would like to read more information about delayed ejaculation, please click on the links below.
- How long should I last?
- How common is Delayed Ejaculation?
- Causes and Risk Factors for Delayed Ejaculation
- How is Delayed Ejaculation Diagnosed?
- What does Therapy for Delayed Ejaculation involve?
- What outcomes and benefits can I expect from Therapy for Delayed Ejaculation?
- Preventing Delayed Ejaculation
- Further information on delayed ejaculation
HOW LONG SHOULD I LAST?
There is no definitive answer. Each person is different and each time we have sex or masturbate is different. The research of Alfred Kinsey in the 19740s, suggests that approximately 48% of men and 52% of women achieved orgasm through intercourse within five minutes (Gebhard & Johnson, 1979/1998). Around 23% of men and 19% of women reported lasting longer than 10 minutes. These data are old and many questions have been raised about Kinsey’ work and its validity.
A survey of Canadian and American sex therapists ideas about how long sex “should” last, reported that average time for heterosexual intercourse was around 7 minutes, with 3 to 7 minutes considered adequate (Corty & Guardiani, 2008). One to two minutes was considered to be too short while 10 to 13 minutes was considered too long.
A recent Australian study results indicate that of 420 men who reported on time to ejaculation, approximately one-quarter (n = 101) reported ejaculation within two minutes of penetration and three-quarters of the participants reported lasting two minutes or more. The following table contains data about duration of penetration to ejaculation.
|Duration of penetration||Less than 1 min||1-2 mins||2-5 mins||5-10 mins||10-20 mins||Longer than 20 mins|
Adapted from Harrison et al (2013)
Given the variety in sexual functioning, sexual need, and that each person and time we have sex is different, there is no answer. It is more important to focus on satisfaction of both partners and to remember sex is an experience and is more than just intercourse – foreplay is important too.
If you or your partner begin to feel discomfort during sexual intercourse, or are concerned at the difficulty you experience in achieving orgasm or ejaculation, it is best to consult a psychosexual/sex therapist.
HOW COMMON IS DELAYED EJACULATION?
There limited information on the frequency delayed ejaculation occurs in the population. One source suggests it is as high as 12% (Baum, n.d.). Masters and Johnston’s research from the 1960 reported the rate as low as 4%.
According to results of the Australian Study of Health and Relationship, 6.3% of the 8,517 men sampled reported they “were unable to reach orgasm” (Richters et al., 2003). The rate of reporting is higher in the older age groups 40-49 years and 50-59 years See table below). Through my practice I am seeing more younger men seeking therapy for delayed ejaculation. One reason for the lower reporting rates among younger men is the belief that lasting longer is better – a sexual misconception.
|Age Group||16-19 yrs
n = 395
n = 1,912
n = 2,271
n = 2,054
n = 1,735
CAUSES AND RISK FACTORS OF DELAYED EJACULATION,
Factors which can increase your risk of delayed ejaculation include:
- Psychological issues or conditions like depression or anxiety
- Stress and anxiety, especially about sex
- Masturbation frequency, sexual activity frequency, and masturbation technique
- Older age — as men age, it is normal for ejaculation to take longer
- Relationship issues/stress
- Alcohol and/or other substance use, especially if you’re a long-term drug user or heavy drinker
- Chronic health or medical conditions, such as diabetes or multiple sclerosis
- Certain medical treatments, such as prostate surgery
- Medications, particularly certain antidepressants, high blood pressure medications or diuretics
- Psychological Causes
Psychological causes of delayed ejaculation may include:
- Lack of attraction for a partner
- Conditioning caused by a habit of unusual masturbation
- Traumatic events (such as being discovered masturbating or having illicit sex, or learning one’s partner is having an affair)
- Anger toward the partner or other relationship issues, like poor communication
- Depression, anxiety or other mental health conditions
- Performance anxiety
- Cultural or religious taboos particularly if the belief makes the person view sex as sinful
- Differences between the reality of sex with a partner and sexual fantasies
Physical causes of delayed ejaculation may include:
- Nerve damage or injury to the pelvic nerves that control orgasm
- Neurological diseases, such as diabetic neuropathy, stroke or nerve damage to the spinal cord
- Prostate surgery, such as transurethral resection of the prostate (TURP) or prostate removal
- Heart disease
- Urinary tract infection
- Hormone-related conditions, such as low thyroid hormone (hypothyroidism) or low testosterone
- Birth defects which affect the male reproductive system
Medications and other substances that may result in experiences of delayed ejaculation include:
- Most types of antidepressants
- Certain high blood pressure medications
- Certain diuretics
- Some anti-psychotic medications
- Alcohol — particularly drinking too much (alcohol abuse or alcoholism)
- Recreational drug use (e.g., speed, MDMA, Ecstasy, Ice, GHB, amyl/poppers) Most substances used for recreational purposes will result in experiences of delayed ejaculation. Prolonged use will have a long-term impact on sexual performance including delayed ejaculations.
In some cases, a man may experience an episode or two of delayed ejaculation, or other issue which impacts on ejaculation. The anxiety experienced from this one-off situation can lead to further anxiety and result in a longer-term effect.
HOW IS DELAYED EJACULATION DIAGNOSED?
There are no formal tests to diagnose delayed ejaculation. Delayed ejaculation is diagnosed through the initial sessions of therapy, where a sexual history is taken. You can expect questions about duration to orgasm/ejaculation; how long the issue has been present; how it is affecting you/your partner/your relationship. You will also be asked about masturbation and sexual frequency, techniques, porn useage among a number of other questions. Through the sexual history we can establish the presence, and extent of the issue.
Delayed ejaculation can be defined as mild – men who can experience an orgasm through penetrative Sex (vaginal and/or anal); moderate – cannot ejaculate through intercourse but can during fellatio or manual stimulation; severe – can ejaculate only when alone, or through self-masturbation; and most severe – cannot ejaculate at all, or only with great difficulty (Strassberg & Perelman, 2009). Provided the cause is not medical (several forms of medication can interfere with ejaculation), then in my experience delayed ejaculation responds well to sex
In addition, delayed ejaculation can be described as lifelong – the issue has been present since the beginning, or early, sexual activity; or acquired – delayed ejaculation occurs after a period of “normal” sexual functioning. Lifelong presence of delayed ejaculation occurs in 25% of men with delayed ejaculation, where as situational delayed ejaculation occurs in 75% of cases with delayed ejaculation (McMahon, 2012). Through the sexual history it will be possible to identify whether the delayed ejaculation is situational – only occurs under or during certain sexual acts or with certain people; or generalised – where the delayed ejaculation is not limited to certain acts/people but occurs more generally, or every time.
Based on the diagnosis and your sexual, medical and mental health history, it will be possible to identify the “causes” and assist the therapist to develop an individual and comprehensive treatment plan.
WHAT DOES THERAPY FOR DELAYED EJACULATION INVOLVE?
In the first session (and maybe second session) a detailed history is taken which covers your sexual, medical and general mental health history. This comprehensive history provides important information on the development and maintenance of the issue,a s well as information on potential avenues for treatment. Through the history taking session/s, your therapist will also be able to identify if there are other aspects of delayed ejaculation which may require further investigation by a medical specialist or GP. For example, your therapist may request a medication review from your GP.
Delayed ejaculation is considered to be a sexual issue with a psychological and physical elements. Through therapy you will learn about the psychological triggers and how to deal with them, as well as patterns which help maintain delayed ejaculation. You also learn about arousal and sexual response and undertake “homework” activities to increase your arousal and “re-sensitise” your penis. The “homework” exercises, whether by yourself or with your partner, aim to reduce performance pressure and re-focus on pleasure.
If you are in a relationship your partner will join in some therapy sessions to deal with issues in the relationship. Typically, with men in relationships we assist to re-orient the intimacy from sexual penetration to greater intimacy, which in turns increases arousal and sensitivity. and also your partner is key to success in therapy. Homework with your partner may also include “friction and fantasy” exercises.
Treatment is tailored to each individual and changes according to the individual’s needs and requirements. Self-treatment of delayed ejaculation is often not successful. Treatment for delayed ejaculation has been successful in 70%-80% of cases after 12-18 sessions (Vorvick, 2012).
WHAT OUTCOMES AND BENEFITS CAN I EXPECT FROM THERAPY FOR DELAYED EJACULATION?
Delayed ejaculation often requires between 12 and 18 sessions on average . The average success rate from treatment is 705-80% at the 12-18 session mark (Vorvick, 2012). Treatment commonly requires about 12 – 18 sessions. The average success rate is 70 – 80%.
From therapy for delayed ejaculation, you may achieve the following outcomes:
- Develop an understanding of the underlying issues which impact on delayed ejaculation
- Develop a greater understanding of your sexual response and arousal patterns
- Enhance skills for intimacy and sex
- Develop new ways to increase arousal of you (and your partner)
- Learn skills for stress management
- Increase relationship satisfaction through enhanced relationship skills (incl. communication and intimacy)
PREVENTING DELAYED EJACULATION
Delayed ejaculation can result from any number of psychological and physiological issues. There is no one way to prevent delayed ejaculation. Below are some tips to help prevent this issue occurring.
- Explore different arousal techniques
- Explore gentle masturbation techniques
- Spend more time with your partner to increase intimacy
- Limit or avoid the use of alcohol and other substances
- Regular exercise
- Learn to reduce or better manage stress
- Get help for anxiety or depression
- Make sure you’re getting the treatment you need for any chronic health problems
A healthy attitude about sex and your genitals may also help prevent delayed ejaculation. You cannot force yourself to have a sexual response. The harder you try to have a certain sexual response, the harder it becomes to respond.
Absorb yourself in the sexual pleasure of the moment. Focus on this moment rather than whether you will ejaculate or perform well. Create a relaxed atmosphere where you and/or your partner can focus on the intimacy and pleasure and therefore arousal.
FURTHER INFORMATION ON DELAYED EJACULATION
Delayed Ejaculation @ International Society of Sexual Medicine
Baum, N. (n.d.). Causes of Delayed Ejaculation. Accessed 12/01/14 from http://www.make-love-easily.com/index.html
McMahon, C. (2012). Delayed ejaculation: A management challenge. Medicine Today, 13, 8, 50-57.
Strassberg, D. S., & Perelman, M. A. (2009). Sexual dysfunctions. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed.), (pp. 399–430). NY: Oxford University Press
Vorvick, L.J. (2012). Delayed ejaculation. Medline. Accessed 12/01/14 from http://www.nlm.nih.gov/medlineplus/ency/article/001954.htm
DISCLAIMER: The information contained on this website should be read as general in nature and only provides an overview of the subject matter. It should not be used as a substitute for medical and/or other professional advice. Also consult a trained professional psychosexual therapist or other healthcare provider.
Experiencing difficulties in your sex life or relationship?
Speak to a professional.
Dr. Christopher Fox and the team at Sex Life Therapy provide confidential and individualised sex therapy and relationship therapy to individuals and couples at two locations: Collingwood and Frankston (Mornington Peninsula/Bayside).
Contact the team on (03) 9005 5213 or use the form to request a confidential chat.